经腰部小切口离断性肾盂成形术治疗新生儿巨大肾积水临床疗效

Anderson-Hynespyeloplasty via lumbar mini incision for the treatment of giant hydronephrosis in newborns

目的:探讨经腰部小切口行Anderson-Hynes离断性肾盂成形术治疗肾盂输尿管连接处梗阻致患侧新生儿巨大肾积水的临床疗效。方法:选取2011年6月至2016年6月于本院诊断为肾盂输尿管连接处梗阻致患侧巨大肾积水的20例新生儿作为研究对象,所有患儿均在完善术前各项检查,明确诊断后经腰部小切口行AndersonHynes离断性肾盂成形术。切口平均2. 6 cm,术中均留置3F双J管于患侧输尿管内作支撑管。术后4~5 d拔除肾周引流管,术后4~6周用7. 5F小儿输尿管镜拔除双J管。结果:20例患儿手术均获成功,无术中并发症发生。平均手术时间82 min,术中吸尽肾盂内尿液,平均尿量为175 mL,术中平均出血量7 mL,术后平均住院时间10 d。术后12个月所有患儿均采用超声、放射性核素扫描随访,显示患侧肾实质均有不同程度增厚,其肾盂前后径值减少明显,患肾分肾功能明显改善,肾盂输尿管连接处吻合口通畅,腰部手术部位瘢痕小且隐蔽。结论:经腰部小切口行Anderson-Hynes离断性肾盂成形术治疗肾盂输尿管连接处梗阻致新生儿巨大肾积水安全可行,疗效良好,值得推广。

Objective:To evaluate the effect of Anderson-Hynespyeloplasty via lumbar mini incision for the treatment of giant hydronephrosis in newborns with ureteropelvic junction obstruction.Methods:Twenty giant hydronephrosis in newborns with ureteropelvic junction obstruction from June 2011 to June 2016 were enrolled in the study.These patients were treated with Anderson-Hynespyeloplasty via lumbar mini incision.The average length of operative incision was 2.6 cm.Double-J tubes were placed intraoperatively in the forming ureters.Their perinephric drainage tubes were removed after approximately 4-5 days of operation,and the 3 F double-J tubes were removed with 7.5 F children ureteroscope after 4-6 weeks of operation.Results:Success rate of the operation was 100%.The average urine volume in their pelvis during the operation was 175 mL,mean intraoperative bleeding volume was 7 mL,and their average postoperative hospitalization time was 10 days.The diameter of renal pelvis was reduced gradually after operation.The thickness of renal cortex increased gradually after operation.The renal function of the affected kidneys was obviously improved.The ureteropelvic junction obstruction was dissolved successfully during follow-up of 12 months after operation.In addition,their operative scars were small and concealed.Conclusion:Anderson-Hynespyeloplasty via lumbar mini incision is safe and feasible in the treatment of giant hydronephrosis in newborns caused by ureteropelvic junction obstruction.